There are physical, emotional, mental and spiritual changes that occur as death approaches. Each person is unique, however, and all these changes may not occur for each person. They may also occur at different times for different people.

One to Three Months Before Death

  • Decrease interest in eating and drinking
  • Withdrawal begins from loved ones, activities and surroundings
  • Sleeps more and feels tired
  • Needs to take care of unfinished business

Several Weeks to Days Before Death

  • Increased restlessness, confusion, agitation
  • Withdrawal from loved ones and activities
  • Sleeps more and feels tired
  • Eats and drinks less or may stop eating and drinking
  • May be unable to swallow
  • Pauses in breathing
  • Unusual dreams and visions
  • Fluctuations in body temperature, blood pressure and pulse
  • Changes in skin color and mottling of skin

Several Days to Hours Before Death

  • Decrease in fluid and food intake
  • Turning inward and eventually in a deep sleep
  • When awakened, may still remain in a “dream reality”
  • Sensitivity to light
  • Unfocused and unseeing eyes
  • Communication becomes more nonverbal
  • Restlessness and terminal agitation
  • Long pauses between breaths alternating with shallow, pant-like breaths
  • Secretions in throat causing a rattle sound
  • Urinary and bowel changes including incontinence or difficulty passing stool
  • Difficulty regulating body temperature
  • Blood pressure drops and often heart beats rapidly

Signs of Imminent Death

  • Lips, hands and feet may be bluish in color
  • Arms, legs and feet may appear mottled
  • Hands and feet may be cold to touch
  • Eyes may have a fixed, glassy stare
  • Breathing though their mouth with long pauses between breaths
  • May not respond to voices

Remember most will choose the time of their death, waiting for a certain family member to arrive to say good-bye, or until everyone goes out of the room so they can die alone.  The way we die usually mimics the way we live.
Signs of death

  • No breathing or heartbeat
  • Eyes are enlarged with fixed pupils
  • Jaw is relaxed and mouth may be open
  • Loss of bladder and bowel control

A sacred time follows the death of a loved one.  Take as much time as you need to be with your loved one’s body. If the patient dies on hospice, funeral homes can be called any time in the first 24 hours. Check with your hospice worker. Some suggested activities during this sacred time.

  • Gather to offer meaningful prayers or sacred readings for your love one.
  • Gently wash the body, coming hair and applying scented oil or lotion.
  • Dress loved one in special clothing
  • Acknowledge their life with a meaningful ritual
  • Light a candle, play music, share prayers in their honor

Marty Hogan, L. M. (2007). If I Should Die…The Dying Process. Ashland, Oregon: Sacred Vigil Press.